Ministry of Health

Republic of Kenya.

Basic Paediatric Protocols

Table of Contents.

Topic Page Number

Acknowledgements / Principles / Policies 3

Drugs
Basic Formulary 6
Emergency drugs – dose charts
• Diazepam and Glucose 8
• Phenobarbitone and Phenytoin 9
Intravenous antibiotics (age > 7 days) 10
Oral antibiotics 11
Maintenance Fluid / Feed Volumes – not malnourished 12

Emergency care guidelines

Triage 13
Infant / Child resuscitation 14
Newborn resuscitation 15

Management guidelines
Convulsions 16
Diarrhoea / dehydration 17
• Fluids for severe and some dehydration 18
HIV 19
Malaria 20
• Malaria drug doses 21
Malnutrition 22
• Emergency fluids & feed recipes 23
• Feeding 24
Meningitis 25
Newborn Care
• Neonatal Sepsis / Prematurity / VLBW 26
• Newborn feeds / fluids (ages 1 – 7 days) 28
• Newborn drugs (ages 1 – 6 days) 29
Respiratory disorders
• Pneumonia 30
• Asthma 32

Weight for Age estimation 33

2
Foreward.

This pocket book is for use by doctors, clinical officers, senior nurses and
other senior health workers who are responsible for the care of young
children at the first referral level where basic laboratory facilities and
essential drugs are available. The guidelines require the hospital to have:-
(1) capacity to do certain essential investigations such as blood smear for
malaria parasites, estimation of haemoglobin or packed cell volume, blood
glucose, blood grouping and cross matching, basic microscopy of CSF and
urine, bilirubin determination for neonates, and chest X-rays and (2)
essential drugs available for the care of seriously sick children.

These guidelines focus on the inpatient management of the major causes

of childhood mortality such as pneumonia, diarrhoea, malaria, severe
malnutrition, meningitis, HIV, neonatal and related conditions. The basis of
these guidelines is the WHO IMCI Manual, “The Management of the Child
with a Serious Illness or Severe Malnutrition.” This booklet is a result of a
workshop in Machakos in February 2004 drawing together experienced
paediatricians from the Ministry of Health, Kenyatta National Hospital,
KEMRI and the University of Nairobi. It deals with the management of
seriously ill children in the first 48 hours.

This handy pocket sized booklet will also be useful to students in medical
schools and other training institutions. The simplified algorithms in this book
can be enlarged and used as job aides in casualty, outpatients, paediatric
wards, delivery rooms and newborn units.

Guidelines of this nature will require periodic revision to keep abreast with
new developments and hence continue to deliver quality care to the
children of this nation.

Dr. James Nyikal, MBS.

Director of Medical Services.

3
Principles of good care:

1) Hospitals must have basic equipment and drugs in stock at all times
(see list of essential items).
2) Sick children coming to hospital must be immediately assessed (triage)
and if necessary provided with emergency treatment as soon as
possible.
3) Assessment of diagnosis and illness severity must be thorough and
treatment must be carefully planned. All stages should be accurately
documented.
4) The protocols provide a minimum, standard and safe approach to most,
but not all, common problems. Care needs to be taken to identify and
treat children with less common problems rather than just applying the
protocols without thinking.
5) The parents / caretakers need to understand what the illness and its
treatment are. They can often then provide invaluable assistance caring
for the child. Being polite to parents considerably improves
communication.
6) The response to treatment needs to be assessed. For very severely ill
children this may mean regular review in the first 6 – 12 hours of
admission – such review needs to be planned between medical and
nursing staff.
7) Correct supportive care – particularly adequate feeding - is as important
as disease specific care.
8) Laboratory tests should be used appropriately and use of unnecessary
drugs needs to be avoided.
9) An appropriate discharge and follow up plan needs to be made when the
child leaves hospital.
10)Good hand washing practices and good ward hygiene improve
outcomes of admission.

4
Specific policies:

 All admissions should receive Vitamin A unless they have received a

dose within the last 1 month. (Malnourished children with eye signs
receive repeated doses).
 All newborn admissions aged < 14 days should receive Vitamin K unless
it has already been given.
 Routine immunization status should be checked and missed vaccines
given before discharge.

Admission and Assessment:

 All admitted children must be weighed, the weight recorded and used for
calculation of drug doses.
 Respiratory rates must be counted for 1 minute.
 Conscious level should be assessed on all children admitted using the
AVPU scale where:
o A = Alert and responsive
o V = responds to Voice or Verbal instructions, eg turns head to
mother’s call. These children may still be lethargic or unable to
drink / breastfeed (prostrate).
o P = responds to Pain appropriately. In a child older than 9 months a
painful stimulus such as rubbing your knuckles on the child’s sternum
should result in the child pushing the hand causing the pain away. If
the child manages this but does not respond to a voice they are in
this ‘P’ category. If the child only lifts or bends the arms but is not able
to locate the hand causing the pain they have failed this test and are
unconscious. In a child 9 months and younger they do not reliably
locate a painful stimulus, in these children if they bend the arms
towards the pain and make a vigorous, appropriate cry they respond
to pain = ‘P’. Children in this category must be lethargic or
unable to sit up or drink / breastfeed (prostrate).
o U = Unconscious, cannot push a hand causing pain away or fail to
make a response at all.
 Children with AVPU = P or U should have their blood glucose checked. If
this is not possible treatment for hypoglycaemia should be given.
 The sickest children on the ward should be near the nursing station and
prioritized for re-assessment / observations.

5
Essential Drugs Doses

Adrenaline 1 in 1000 0.01ml / kg s.c. for severe asthma

To make this strength dilute 1 ml of 1 in 1000
Adrenaline 1 in 10,000 adrenaline in 9 mls water for injection to make
10mls. Give 0.1ml/kg in resuscitation.
Aminophylline- iv Newborn Loading dose 6mg/kg iv over 1 hour or
rectal, Maintenance (or oral): Age 0-7 days -
2.5mg/kg 12hrly, Age 7-28 days 4mg/kg 12hrly.
Asthma: 6mg/kg iv first dose over 30 mins then
5mg/kg 6hrly
Aminophylline - oral Asthma: 6mg/kg 6hrly
Amodiaquine (200mg tabs) od for 3 days, <7kg 1/4 tab, 7-9kg 1/2, 1/2, 1/4
tab, 10-14kg 3/4, 3/4, 1/2 tab, 15-18kg 1,1,3/4
tab
Amoxycillin See separate chart
Benzyl Penicillin (X-pen) See separate chart
Brufen / Ibuprofen 5 - 10 mg/kg 8 hourly
Ceftriaxone / Cefotaxime See separate chart
Chloramphenicol - injection See separate chart
Chloramphenicol - oral See separate chart
Clotrimazole 1% Apply paint / cream daily
Dexamethasone For severe croup 0.6mg/kg stat
(Flu) Cloxacillin - injection See separate chart
(Flu) Cloxacillin - oral See separate chart
Co-artem See separate chart
Co-trimoxazole (4mg/kg 240mg/ml syrup 480mg tabs
Weight
Trimethoprim & 20mg/kg 12hrly 12hrly
sulphamethoxazole) 3-6 kg 2mls 1/4
7-9 kg 3.5mls 1/2
10-14 kg 6mls 1
15-20 kg 8.5mls 1
Diazepam - injection 0.3mg/kg & See separate chart
Diazepam - rectal 0.5mg/kg & See separate chart
Digoxin 15 micrograms/kg Loading dose then 5
micrograms/kg 12 hrly
Frusemide 0.5 to1mg/kg up to 6 hrly
Gentamicin See separate chart
Glucose 5mls/kg 10% dextrose & See separate chart

6
Iron tabs / syrup 200mg tabs Syrup 100mg/5mls
200mg Ferrous sulphate tabs
Weight
Once daily Once daily
100mg /5mls Ferrous 3-6 kg - 1ml
fumarate syrup 7-9 kg 1/4 1.25ml
10-14 kg 1/2 2mls
15-20 kg 1/2 2.5mls
Mebendazole (age > 1yr) 100mg bd for 3 days or 500mg stat
Metronidazole - oral See separate chart
Multivitamins <6 months 2.5mls daily, >6months 5mls 12 hrly
Nalidixic acid See separate chart
Nystatin 1ml 6hrly (2 weeks in HIV positive children)
Paracetamol 10-15mg / kg 6 to 8 hrly
Pethidine, im 0.5 to 1mg / kg every 4- 6 hours
Phenobarbitone - injection See separate chart
Phenobarbitone - oral See separate chart
Potassium - oral 1 - 4 mmol/kg/day
Prednisolone - tabs Asthma 1mg / kg daily (usually for 3 days)
Quinine injection See separate chart
Quinine tabs See separate chart
Salbutamol Inhaled (100 microgram per puff) 2 puffs via
spacer repeated as required in an emergency or
2 puffs up to 4-6 hrly for maintenance or
outpatient treatment.
Nebulised 2.5mg/dose as required (see asthma
chart)
Oral 1mg/dose 6-8hrly aged 2-11 months,
2mg/dose 6-8hrly aged 1 - 4 yrs
TB drugs See national guidelines
Vitamin A Age
Once on admission, not to
be repeated within 1 month. < 6 months 50,000 u
For malnutrition with eye 6 – 12 months 100,000 u
disease repeat on day 2
and day 14 > 12 months 200,000 u
Vitamin K Newborns: 1mg stat im (<1500g, 0.5mg im stat)
For liver disease: 0.3mg/kg stat, max 10mg
Zinc >6 months : 20mg/day for 14 days.
<6months : 10mg/day for 14 days.

7
 Emergency drugs – Diazepam and Glucose.

Diazepam Glucose,
(The whole syringe barrel of a 1ml or 2ml syringe should be inserted
gently so that pr DZ is given at a depth of approx. 5cm)
5mls/kg of 10% glucose over 5 - 10 minutes
Weight, iv iv pr pr iv
(kg) mls of
Dose, Dose, mls of 10mg/2ml Total Volume of 10%
10mg/2ml To make 10% glucose
0.3mg/kg 0.5mg/kg solution Glucose
solution
3.00 1.0 0.20 1.5 0.3 15
4.00 1.2 0.25 2.0 0.4 20
5.00 1.5 0.30 2.5 0.5 25 10 mls syringe:
6.00 1.8 0.35 3.0 0.6 30  2 mls 50% Glucose
7.00 2.1 0.40 3.5 0.7 35  8 mls Water for
8.00 2.4 0.50 4.0 0.8 40 injection
9.00 2.7 0.55 4.5 0.9 45
10.00 3.0 0.60 5.0 1.0 50 20 mls syringe:
 4 mls 50% Glucose
11.00 3.3 0.65 5.5 1.1 55
 16 mls Water for
12.00 3.6 0.70 6.0 1.2 60
Injection
13.00 3.9 0.80 6.5 1.3 65
14.00 4.2 0.85 7.0 1.4 70 50 mls syringe:
15.00 4.5 0.90 7.5 1.5 75  10 mls 50%
16.00 4.8 0.95 8.0 1.6 80 Glucose
17.00 5.1 1.00 8.5 1.7 85  40 mls Water for
18.00 5.4 1.10 9.0 1.8 90 Injection
19.00 5.7 1.15 9.5 1.9 95
20.00 6.0 1.20 10.0 2.0 100

8
 Anticonvulsant drug doses and adminstration.

Weight Phenobarb, Phenobarb, Phenobarb Phenytoin, Phenytoin,

(kg) Loading dose, maintenance, maintenance loading dose, maintenance
15mg/kg 5mg/kg daily 2.5mg/kg daily 15mg/kg 5mg/kg daily
(high dose – (starting dose – acute
chronic therapy) febrile illness)
im / oral im / oral im / oral Oral / ng Oral / ng
2.00 30 10 5 Tablets may be crushed and put
2.50 37.5 12.5 6.25 down ngt if required.
3.00 45 15 7.5 45 15
4.00 60 20 10 60 20
5.00 75 25 12.5 75 25
6.00 90 30 15 90 30
7.00 105 35 17.5 105 35
8.00 120 40 20 120 40
9.00 135 45 22.5 135 45
10.00 150 50 25 150 50
11.00 165 55 27.5 165 55
12.00 180 60 30 180 60
13.00 195 65 32.5 195 65
14.00 210 70 35 210 70
15.00 225 75 37.5 225 75
16.00 240 80 40 240 80
17.00 255 85 42.5 255 85
18.00 270 90 45 270 90
19.00 285 95 47.5 285 95
20.00 300 100 50 300 100

9
 Intravenous / intramuscular antibiotic doses – Ages 7 days and older.

Weight Penicillin Ampicillin or Chloramphenicol Gentamicin Ceftriaxone Metronidazole

(kg) (50,000iu/kg) Cloxacillin (25mg/kg) (7.5mg/kg) (50mg/kg) (7.5mg/kg)
(50mg/kg)
iv / im iv / im iv / im im iv / im iv
6hrly - meningitis Meningitis -12 hrly 12 hrly < 1m, ≥
6 hrly 8 hrly 8hrly – V.S. LRTI 24 hrly Other – 24 hrly 1m 8 hrly
3.0 150,000 150 75 20 150 20
4.0 200,000 200 100 30 200 30
5.0 250,000 250 125 35 250 35
6.0 300,000 300 150 45 300 45
7.0 350,000 350 175 50 350 50
8.0 400,000 400 200 60 400 60
9.0 450,000 450 225 65 450 65
10.0 500,000 500 250 75 500 75
11.0 550,000 550 275 80 550 80
12.0 600,000 600 300 90 600 90
13.0 650,000 650 325 95 650 95
14.0 700,000 700 350 105 700 105
15.0 750,000 750 375 110 750 110
16.0 800,000 800 400 120 800 120
17.0 850,000 850 425 125 850 125
18.0 900,000 900 450 135 900 135
19.0 950,000 950 475 140 950 140
20.0 1,000,000 1000 500 150 1000 150
NB. Double Penicillin doses if treating Meningitis and age > 1 month

10
 Oral antibiotic doses

Cloxacillin /
Amoxycillin, oral, Chloramphenicol Nalidixic acid Metronidazole
Flucloxacillin
25mg/kg/dose 25mg/kg/dose 15mg/kg/dose 7.5mg/kg/dose
15mg/kg/dose
250mg
mls susp mls susp 250mg caps mls susp 250mg
caps or 500mg tabs 200mg tabs
125mg/5ml 125mg/5ml or tabs 125mg/5ml caps
tabs
Weight 6 hrly
12 hrly 12 hrly 8 hrly 8 hrly 6 hrly 6 hrly 8 hrly
kg (> 3m age)
3.0 5 1/2 2.5 1/4 4
4.0 5 1/2 2.5 1/4 4 1/8 1/4
5.0 5 1/2 5 1/4 6 1/8 1/4
6.0 5 1/2 5 1/2 6 1/4 1/2
7.0 7.5 1/2 5 1/2 8 1/4 1/2
8.0 7.5 1/2 5 1/2 8
1/4 1/2
9.0 7.5 1 5 1/2 8
10.0 10 1 5 1 12 1 1/4 1/2
11.0 10 1 10 1 12 1 1/2 1/2
12.0 10 1 10 1 12 1 1/2 1/2
13.0 10 1 10 1 12 1 1/2 1/2
14.0 15 1 1/2 10 1 12 1 1/2 1
15.0 15 1 1/2 10 1 15 1 1/2 1
16.0 15 1 1/2 10 1 15 1 1/2 1
17.0 15 1 1/2 10 1 15 1 1/2 1
18.0 15 1 1/2 10 1 15 1 1/2 1
19.0 20 2 10 1 15 1 1/2 1
20.0 20 2 10 1 2 1/2 1
11
Initial Maintenance Fluids / Feeds – Normal Renal Function.

Note:
• Children should receive 1-2 mmol / kg / day of potassium
• Feeding should start as soon as safe and infants may rapidly increase to
150mls/kg/day of feeds as tolerated (50% more than in the chart).
• Add 50mls 50% dextrose to 450mls Half Strength Darrow’s to make
HSD/5% dextrose a useful maintenance fluid.
• Drip rates are in drops per minute
Drip rate - Drip rate - 3hrly bolus
Weight, Volume in Rate in
adult iv set, paediatric burette feed
kg 24hrs mls / hr
20 drops = 1ml 60 drops = 1ml volume
3 300 13 4 13 40
4 400 17 6 17 50
5 500 21 7 21 60
6 600 25 8 25 75
7 700 29 10 29 90
8 800 33 11 33 100
9 900 38 13 38 110
10 1000 42 14 42 125
11 1050 44 15 44 130
12 1100 46 15 46 140
13 1150 48 16 48 140
14 1200 50 17 50 150
15 1250 52 17 52 150
16 1300 54 18 54 160
17 1350 56 19 56 160
18 1400 58 19 58 175
19 1450 60 20 60 175
20 1500 63 21 63 185
21 1525 64 21 64 185
22 1550 65 22 65 185
23 1575 66 22 66 185
24 1600 67 22 67 200
25 1625 68 23 68 200

12
Triage of sick children.

Emergency Signs:
If history of trauma ensure cervical spine is protected.

Airway &  Obstructed breathing

Breathing  Central Cyanosis
 Severe respiratory distress Immediate transfer to
 Weak / absent breathing emergency area:
 Start Life support
Cold Hands with: procedures
Circulation  Capillary refill >  Give oxygen
3seconds  Weigh if possible
 Weak + fast pulse
 Slow (<60bpm) or absent
pulse

Coma / convulsing / confusion : AVPU = ‘P or U’ or Convulsions

Diarrhoea with sunken eyes → assessment / treatment for severe dehydration

Priority Signs

 Tiny - Sick infant aged < 2 months

 Temperature – very high > 39.50C
 Trauma – major trauma Front of the Queue -
 Pain – child in severe pain Clinical review as
 Poisoning – mother reports poisoning soon as possible:
 Pallor – severe palmar pallor
 Restless / Irritable / Floppy  Weigh
 Respiratory distress  Baseline
 Referral – has an urgent referral letter observations
 Malnutrition - Visible severe wasting
 Oedema of both feet
 Burns – severe burns

Non-urgent – Children with none of the above signs.

13
Basic Life Support – Cardio-respiratory collapse.

Call for Help! - Rapidly move child to emergency area

1) Position head to open airway, 2) Clear airway if obstructed, 3) Start oxygen

Assess breathing – look, listen, feel for 5 seconds

No breathing Adequate breathing

Give 5 rescue breaths with bag and

mask – if chest doesn’t move check Support airway
airway open and mask fit and repeat. Continue oxygen

After at least 2 good breaths

Check the pulse for 10 seconds

Pulse palpable and
>60bpm
No or weak, slow pulse

Give 15 chest compressions then 1) Continue airway / breathing

continue giving 15 chest compressions support & oxygen,
for each 2 breaths for 1 minute. 2) Look for signs of dehydration
/ poor circulation and give
emergency fluids as
Re-assess ABC
necessary,
No change 3) Consider treating
hypoglycaemia,
1) iv 0.1ml/kg 1 in 10,000 Adrenaline 4) Continue full examination to
2) Continue 15 chest compressions : 2 establish cause of illness and
breaths for 3 minutes, treat appropriately.
3) Consider first fluid bolus 20 mls/kg
Ringers or saline, then,
4) Reassess ABC Improvement
No change

Give 2nd dose Adrenaline, consider further fluid bolus and treatment
of hypoglycaemia then 3 further minutes CPR.

14
 Neonatal Resuscitation – Call for help!
Dry baby with clean cloth and There is no need to slap the baby,
A
place where the baby will be drying is enough.
warm.
Meconium If baby floppy / blue / apnoeic suck oro-
A pharynx under direct vision. Do not suck
right down the throat as this can make the
baby stop breathing and bradycardic.
Breathing / Crying / Active / Pink?
Yes
No
Routine care.
A Position the head of the baby
in the neutral position to open
the airway.
Make sure the chest moves up with
each press on the mask and in a very
B Use a correctly fitting mask small baby make sure the chest does
and give the baby 5 good not move too much. Aim for 2 secs
inflation breaths. inspiration, 0.5 secs expiration for
first 5 breaths.
C Check the heart rate (femoral If HR < 60 bpm CALL
pulse, cord pulsation or by for help!
listening)
Compress the chest (1cm
below the line connecting
Continue to bag at about 30 the nipples on the sternum)
breaths per minute making pushing down 1.5 cm at a rate
sure the chest is moving of 100 per minute.
adequately. Every 1 –2
minutes stop and see if the
pulse or breathing have If you are alone perform 3 chest
improved. Stop when HR>100 compressions for each 1 breath.
and RR>30 and provide CALL FOR HELP!
oxygen.

Consider giving 5mls/kg of 10% glucose after 3-4 minutes of

resuscitation if there is no response, if TWO people are present. Do
NOT stop ventilation / cardiac compressions to give glucose.

15
Treatment of convulsions.
Convulsions in the first 1 month of life should be treated with Phenobarbitone
20mg/kg stat, a further 5-10mg/kg can be given within 24 hours of the loading
dose with maintenance doses of 5mg/kg daily.

Age > 1 month.

Child Y 1) Make sure the environment is safe.

convulsing for 2) Give iv diazepam 0.3mg/kg slowly over 1
more than 5 minute, OR rectal diazepam 0.5mg/kg.
minutes 3) Start oxygen.
N 4) Check glucose / give 5mls/kg 10%
glucose
Child having 3rd 5) Check airway is clear when fit stopped.
convulsion lasting
<5mins in < 2 hours.*
N Y Convulsion stops
Observe and investigate by 10 minutes?
cause. N
Y
Treatment:
6) Give iv diazepam 0.3mg/kg slowly over 1
minute, OR rectal diazepam 0.5mg/kg.
7) Continue oxygen.
8) Check airway is clear when fit stopped.

Observe and investigate Y Convulsion stops

cause. by 15 minutes?
N
Treatment:
9) Give im phenobarbitone 15mg/kg – DO NOT
* If children have give more than 2 doses of diazepam in 24
up to 2 fits hours once phenobarbitone used.
lasting <5 mins
they do not
10)Maintenance therapy should be initially with
require phenobarbitone 2.5mg/kg OD x 48 hrs.
emergency drug 11)Continue oxygen during active seizure.
treatment. 12)Check airway is clear when fit stopped.
13)Investigate cause.
Do not give a phenobarbitone loading dose to an epileptic on maintenance phenobarbitone

16
Diarrhoea / GE protocol (excluding severe malnutrition).
Antibiotics are NOT indicated unless there is dysentery or persistent diarrhoea and proven
amoebiasis or giardiasis. Diarrhoea > 14 days may be complicated by intolerance of ORS –
worsening diarrhoea – if seen change to iv regimens.

History of diarrhoea / vomiting, age > 2 months

CHECK for SHOCK. Y N/Saline 20mls/kg over 15 minutes,

Cold hands plus pulse weak boluses may be given up to 4 times or
/ absent i)and either: until improvement (return of pulse).
• Capillary refill > 3 secs Treat for hypoglycaemia.
• AVPU < A
NB if Hb<5g/dl transfuse urgently,
20mls/kg.
N iv Step 1 - 30mls/kg
Ringer’s over 30 mins if
Y age ≥ 12m, over 60 mins
SEVERE Dehydration.
(Plan C) if age < 12m.
Unable to drink or AVPU OR
< A plus:
iv Step 2 - 70mls/kg Ringer’s over 2.5
 sunken eyes
hrs age ≥ 12m, over 5 hrs age <12m.
 return of skin pinch ≥2
secs
ngt rehydration – 100mls/kg
ORS over 6 hours
N
Re-assess at least hourly, after 3 - 6 hours re-classify as severe,
some or no dehydration and treat accordingly.

SOME DEHYDRATION Y 1.Plan B, ORS by mouth at 75mls/kg over

Able to drink adequately 4 hours, plus, Zinc 20mg per day for 14 days
but 2 or more of: for children over 6 months and 10 mg/day for
children<6months
 Sunken eyes
2. Continue breast feeding as tolerated
 Return of skin pinch 1-2 Reassess at 4 hours, treat according to
sec’ds classification.
 Restlessness / irritability
NDrinks eagerly

NO DEHYRATION Y Plan A 10mls/kg ORS after each loose

Diarrhoea / GE with fewer
than 2 of the above signs
of dehydration.
stool. Zinc 20mg per day for 14 days for
children over 6 months
Continue breast feeding and encourage
feeding if > 6 months

17
 Urgent Fluid management – Child WITHOUT severe malnutrition.*
Plan C – Step 1 Plan C – Step 2 Plan B - 75mls/kg
Shock,
20mls/kg 30mls/kg Ringer’s 70mls/kg Ringer’s or ng ORS Oral / ng ORS
Ringer’s or Age <12m, Age ≥ 1yr,
Weight Saline Age <12m, 1 hour
over 5 hrs Volume over 2½ hrs Over 4 hours
kg Immediately Age ≥1yr, ½ hour
= drops/min** = drops/min**
2.00 40 50 10 150 ** Assumes 150
2.50 50 75 13 200 ‘adult’ iv 150
giving sets
3.00 60 100 13 200 where 200
4.00 80 100 20 300 20drops=1ml 300
5.00 100 150 27 400 55 350
6.00 120 150 27 400 55 450
7.00 140 200 33 500 66 500
8.00 160 250 33 500 66 600
9.00 180 250 40 600 80 650
10.00 200 300 50 700 100 750
11.00 220 300 55 800 110 800
12.00 240 350 55 800 110 900
13.00 260 400 60 900 120 950
14.00 280 400 66 1000 135 1000
15.00 300 450 66 1000 135 1100
16.00 320 500 75 1100 150 1200
17.00 340 500 80 1200 160 1300
18.00 360 550 80 1200 160 1300
19.00 380 550 90 1300 180 1400
20.00 400 600 95 1400 190 1500
*Consider Immediate blood transfusion if severe pallor or Hb <5g/dl on admission

18
HIV – who to test and how to manage.

Discuss HIV testing if the child has 3 or more key criteria:

 History of 2 or more episodes of persistent diarrhoea

 Family history of TB within 5 years or confirmed HIV infection in parent(s).
 Weight < 3% weight for age (below low weight line on RTH card)
 Lymphadenopathy > 1cm at 2 or more sites
 Oral thrush (age > 2 months)
 Pneumonia at presentation

Other signs that should make you consider the diagnosis of HIV include:
Shingles (Herpes Zoster), persistent unexplained fever, chronic parotitis.
Children being treated for TB should be HIV screened.

Immediate Treatment.
1) Treat the presenting problems in the same way as for an HIV negative
child.
2) If the child is known to be HIV positive on admission and presents with
very severe pneumonia consider treatment for Pneumocystis
pneumonia immediately.
3) If Pneumocystis is suspected after admission establish HIV status
before treating Pneumocystis pneumonia.

Signs suggesting Pneumocystis pneumonia include:

 Fast breathing (especially very high rates > 70 bpm)
 Hypoxia / cyanosis
 Absence of crackles and wheeze
 Age < 12 months
 Bilateral interstitial infiltrates on chest X ray are sometimes seen.

Treat and prevent Pneumocystis pneumonia with Co-trimoxazole (CTZ)

Weight CTZ syrup CTZ Tabs Frequency

240mg/5mls 480mg/tab
1-4 kg 2.5 mls 1/4 24hrly for
5-8 kg 5 mls 1/2 prophylaxis,
9-16 kg 10 mls 1 6 hrly for 3wks for
17-50 kg 2 PCP treatment

Ongoing Treatment.
1) Refer child and carers to an HIV support clinic.
2) If breast fed encourage exclusive breast feeding until 6 months then
rapid weaning. If an alternative to breast feeding is affordable, feasible,
accessible, safe and sustainable (AFASS) discuss this option.
19
 Malaria Treatment in malaria endemic areas.
If a high quality blood slide is negative then only children in coma or those
with severe anaemia should be treated presumptively for malaria.
Yes
Coma – AVPU = ‘U’ Treat with iv or im Quinine:
No 1. Loading, 15mg/kg (im or iv over 3hrs) then,
2. 12 hrly doses 10mg/kg (im or iv over 2hrs).
Unable to drink / 3. Treat hypoglycaemia.
Yes
breastfeed – AVPU = ‘V 4. Maintenance fluids / feeds.
or P’, and / or, 5. If weak pulse AND capillary refill >3secs
Respiratory distress with give 20mls/kg Ringer’s until pulse
severe anaemia or with restored (use blood for resuscitation if
acidotic breathing Hb<5g/dl).
6. If Respiratory distress & Hb < 5 g/dl
transfuse 20 mls/kg whole blood
Severe anaemia, Hb<5g/dl, urgently, give over 4 hrs.
alert (AVPU= ‘A’), able to drink
Yes Give Co-artem (oral quinine if
and breathing comfortable.
not available) and iron, if Hb <
No
4g/dl, transfuse 20 mls/kg
Fever, none of the severe signs whole blood over 4hrs urgently
above, able to drink / feed, AVPU = Negative Antimalarial not
‘A’ & reliable malaria test result: required, look for
(If lab unreliable and there is fever another cause of
assume child has malaria & give oral illness. Repeat test if
antimalarial) concern remains.
Positive
If Hb < 9g/dl treat with oral
st
Treat with recommended 1 line oral iron for 14 days initially. If
antimalarial, or 2nd line if 1st line respiratory distress develops
treatment has failed. and Hb < 5g/dl transfuse
urgently.
Treatment failure:
1) Consider other causes of illness / co-morbidity
2) A child on oral antimalarials who develops signs of severe malaria
(Unable to sit or drink, AVPU=U or P and / or respiratory distress) at any
stage should be changed to iv quinine.
3) A child on oral antimalarials who has fever and a positive blood slide
after completing 3 days (72 hours) therapy should receive a full course
of quinine.

20
 Anti-malarial drug doses - ** Please check the tablets.

200 mg Quinine Sulphate = 200mg Quinine Hydrochloride or Dihydrochloride

200 mg Quinine Sulphate = 300mg Quinine Bisuphate
The table below assumes the use of a 200mg Quinine Sulphate tablet.
If the tablets are 300mg Quinine sulphate or dihydrochloride then the
table is NOT appropriate.

For im Quinine take 1ml of the 2mls in a 600mg Quinine suphate iv vial and
add 5mls water for injection – this makes a 50mg/ml solution. Do not give
more than 3mls per injection site. (See nursing chart for more detail)

Quinine loading, Quinine,

15mg/kg maintenance, 10mg/kg Quinine, tabs, 10mg/kg
200mg QN sulphate**
Weight iv infusion / im iv infusion / im 8 hourly
kg Once only 12 hrly
3.0 45 30 1/4
4.0 60 40 1/4
5.0 75 50 1/4
6.0 90 60 1/2
7.0 105 70 1/2
8.0 120 80 1/2
9.0 135 90 1/2
10.0 150 100 3/4
11.0 165 110 3/4
12.0 180 120 3/4
13.0 195 130 3/4
14.0 210 140 3/4
15.0 225 150 1
16.0 240 160 1
17.0 255 170 1
18.0 270 180 1
19.0 285 190 1 1/4
20.0 300 200 1 1/4

21
Co-artem (with food)
Stat, +8hrs, and 12 hrly Age Tabs
Day 2 and Day 3
5 – 15 kg 3 months – 35 months 1 tablet
15 – 24 kg 3 years – 8 years 2 tablets
25 – 34 kg 9 years – 14 years 3 tablets

22
Symptomatic severe malnutrition.
Admit to hospital if there is a history of illness and either of:
 Visible severe wasting (buttocks)
 Oedema and low weight for age or other signs of
Kwashiorkor (flaky paint skin / hair changes).

Check glucose and treat if <3mmol/l (5mls/kg 10%

Step 1 dextrose). If glucose test unavailable treat for
hypoglycaemia if not alert. Oral / ngt glucose or feeds
should as soon as possible (not >30 mins after admission.)

Step 2 Check for hypothermia, axillary temperature <350C. If

present warm with blankets, warm bags of fluid or a heater.

Check for dehydration – use Diarrhoea / Dehydration

Step 3
flowchart to classify then USE fluid plans for severe
malnutrition. (Transfuse if Hb < 4g/dl, or shock + severe
pallor, 10mls/kg whole blood in 3hrs + frusemide 1mg/kg)
Correct electrolyte imbalance. Ideally add Mineral mix to
Step 4 feeds, but at least give 4mmol/kg/day extra of oral
potassium.Never use Frusemide to treat oedema!
Treat infection. All ill children with severe malnutrition should
Step 5 get iv Penicillin (or Ampicillin) AND Gentamicin AND oral
Metronidazole . Add:
 Nystatin / Clotrimazole for oral thrush
 Mebendazole after 7 days treatment.
 TEO (+ atropine drops) for pus / ulceration in the eye

Step 6 Correct micronutrient deficiencies. Give:

 Vitamin A on admission (and days 2 and 14 if eye signs).
 Multivitamins for at least 2 weeks
 Folic acid 2.5mg every other day
 Start iron ONLY when the child is gaining weight.
Step 7 Prescribe feeding needed (see chart) and place ngt.

Steps 8, 9 & 10: Ensure appetite and weight are monitored and start
catch-up feeding (usually day 3 – 7). Provide a caring and stimulating
environment for the child and start educating the family so they help in
the acute treatment and are ready for discharge.

23
Emergency Fluid management in Severe Malnutrition

Shock: Reduced consciousness, absent, slow (<60 bpm) or weak pulse.

15 mls/kg in 1 hr of Half Strength Darrow’s in 5% dextrose.
If HSD in 5% Dextrose not available it can be made by adding
50mls 50% dextrose to 450mls HSD.
If improves
• Repeat this bolus over another 1 hour.
• Then switch to oral of ng fluids using Resomal at 10mls/kg/hour for up to 10 hours.
• As soon as conscious introduce F75 and appropriately reduce amount of Resomal
given.
If does not improve
• Give maintenance iv fluid at 4mls/kg/hr
• Transfuse 10mls/kg whole blood over 3 hours as soon as it is available
• Introduce F75 after transfusion complete.
Oral / ngt Emergency
Shock
Resomal Maintenance
15mls/kg 10mls/kg/hr 4mls/kg/hr
Half-Strength Darrows in 5% HSD in 5%
Resomal
Dextrose Dextrose
iv Oral / ngt iv
Drops/min if
Weight Shock 10mls/kg/hr for Hourly until
20drops/ml
kg = over 1 hour giving set up to 10 hours transfusion
4.00 60 20 40 15
5.00 75 25 50 20
6.00 90 30 60 25
7.00 105 35 70 30
8.00 120 40 80 30
9.00 135 45 90 35
10.00 150 50 100 40
11.00 165 55 110 45
12.00 180 60 120 50
13.00 200 65 130 50
14.00 220 70 140 55
15.00 240 80 150 60

Dried Skimmed Milk Vegetable Oil Sugar Water

F 75* 25g 27g 100g Make up to 1000mls
F 100* 80g 60g 50g Make up to 1000mls
* Ideally add electrolyte / mineral solution and at least add potassium

24
Feeding children with severe malnutrition – use EBM & / or infant formula if aged < 6 months.
1) If respiratory distress or oedema get worse or the jugular veins are engorged reduce feed volumes.
2) When appetite returns (and oedema much improved) change from F75 to F100, for the first 2 days use the same feed volumes as for
F75. Then increase to the minimum F100 volume and continue increasing feeds by 10mls per feed stopping when the child is not
finishing the feeds or if the maximum is reached.
F75 – acute feeding F100 – catch-up feeding
3 hourly feed
No or moderate oedema Severe oedema, even face volume
Weight Total Feeds 3 hourly feed Total Feeds 3 hourly feed Total Feeds
(kg) / 24 hrs volume / 24 hrs volume / 24 hrs Min Max
3.0 390 50 300 40 450 55 80
3.5 455 60 350 45 525 65 95
4.0 520 65 400 50 600 75 110
4.5 585 75 450 60 675 85 120
5.0 650 80 500 65 750 95 135
5.5 715 90 550 70 825 105 150
6.0 780 100 600 75 900 115 165
6.5 845 105 650 85 975 125 175
7.0 910 115 700 90 1050 135 190
7.5 975 120 750 95 1125 140 205
8.0 1040 130 800 100 1200 150 220
8.5 1105 140 850 110 1275 160 230
9.0 1170 145 900 115 1350 170 245
9.5 1235 155 950 120 1425 180 260
10.0 1300 160 1000 125 1500 190 275
10.5 1365 170 1050 135 1575 200 285
11.0 1430 180 1100 140 1650 210 300
11.5 1495 185 1150 145 1725 215 315
12.0 1560 195 1200 150 1800 225 330
25
Meningitis – investigation and treatment.
Age ≥ 60 days and history of fever

LP must be done if there’s one of: Immediate LP to view by

 Coma, inability to drink / feed, eye +/- laboratory
Yes
AVPU = ‘P or U’. examination even if malaria
 Stiff neck, slide positive unless:
 Bulging fontanelle,  Child requires CPR.
 Fits if age <6 months or > 6  Pupils respond poorly to
years, light,
 Evidence of partial seizures  Skin infection at LP site
No

Do an LP unless completely
Yes
 Agitation / irritability, normal mental state after
 Any seizures febrile convulsion. Review
No within 8 hours and LP if
doubt persists.
Meningitis unlikely, investigate other causes of fever.

Interpretation of LP and treatment definitions:

Either Bedside examination:
 Looks cloudy in bottle (turbid) and not a blood stained tap,
And / or Laboratory examination with one or more of (if possible):
 White cell count > 10 x 106/L
 Gram positive diplococci or Gram negative cocco-bacilli,
Yes to one Classify as definite meningitis:
No to all
1) Chloramphenicol, PLUS,
One of: 2) Penicillin,
 Coma, Minimum 10 days of treatment iv / im.
 Stiff neck, Steroids are not indicated.
 Bulging fontanelle,
+ LP looks clear Yes Classify probable meningitis:
1) Chloramphenicol, PLUS,
None of these signs 2) Penicillin,
7 days iv / im treatment then oral
antibiotics to complete 14 days
CSF Wbc result <10 x10 /L6
improvement.
LP looks clear, no Possible Meningitis –iv / im
Yes CSF Wbc count Chloramphenicol & Penicllin
for minimum 3 days or until
No meningitis symptoms resolve.

26
Neonatal Sepsis / Prematurity / LBW / Jaundice

Age < 60 days

Yes
One or more of: Do LP unless severe
 No spontaneous movement respiratory distress
/ unconscious
 Inability to feed,
 Convulsions / abnormal
movements 1) Check for hypoglycaemia,
 Stiff neck treat if unable to measure
 Bulging fontanelle glucose.
 High pitched cry 2) Start gentamicin and
 Apnoeas, penicillin (see chart),
No 3) Give oxygen if cyanosed /
RR > 60 bpm.
One or more of: Yes 4) Give Vitamin K if born at
0 0
 Temp No> 38 C or < 35.5 C home or not given on
 History of difficult breathing, maternity.
 Lower chest wall indrawing, 5) Keep warm.
 Respiratory rate > 60 bpm, 6) Maintain feeding by mouth
 Grunting, Yes
or ngt, use iv fluids only if
 Cyanosis, respiratory distress or
 Pus from ear, severe abdominal
 Pus from umbilicus and distension (see chart).
redness of abdominal skin
 Age < 7 days, unwell and 1) If back arching or fisting or
rupture
No of membranes >24 very high bilirubin consider
hours. transfer for exchange, do
No
septic screen and start
Jaundice: phototherapy
 Bilirubin greater than Yes 2) If jaundice only but no
permitted maximum for age signs of illness begin
/ weight, or, phototherapy.
 Sole of foot clearly deeply
jaundiced A Newborn with weight <2kg
No
& premature delivery or small
No sign of severe illness, size for gestational age with
review if situation changes. reduced ability to suck as the
only problem may only require
warmth, feeding support and
a clean environment.

27
Duration of Treatment for Neonatal / Young Infant Sepsis.
Problem Days of treatment

Signs of Young • Antibiotics could be stopped after 48 hours if the child is

Infant Infection in a feeding well without fever and has no other problem and
child breast feeding LP, if done, is normal.
well. • The child can go home with oral treatment to complete 5
days in total. Advise the mother to return with the child if
problems recur.
Skin infection with • IV / IM antibiotics could be stopped after 48 hours if the
signs of generalised child is feeding well without fever and has no other
illness such as poor problem and LP, if done, is normal.
feeding • Oral antibiotics should be continued for a further 5 days.
Clinical or • IV / IM antibiotics should be continued for a minimum of 5
radiological days or until completely well.
pneumonia. • For positive LP see below.
Severe Neonatal • The child should have had an LP.
Sepsis with coma / • IV / IM antibiotics should be continued for a minimum of 7
inability to feed. days or until completely well if the LP is clear
Neonatal meningitis • IV / IM antibiotics should be continued for a minimum of
or severe sepsis and 14 days.
no LP performed • If Gram negative meningitis is suspected treatment
should be iv for 3 weeks.

Growth, Vitamins and Minerals:

Babies should gain about 10g / kg of body weight every day after the first 7 days of life. If they
are not check that the right amount of feed is being given.
All infants aged < 14 days should receive Vitamin K on admission if not already given.
All premature infants (< 36 weeks or < 2kg) should receive:
• 2.5 mls of multivitamin syrup daily once full milk feeding has started (2 wks)
• 2.5mls of ferrous fumarate suspension daily starting at 4-6 weeks of age for 12 wks.

28
Newborn Feeding / Fluid requirements. Age Daily Fluid / Milk Vol.
 Weight >1.75kg, NO asphyxia or resp. distress start Day 1 60 mls/kg/day
immediate milk feeding
 Weight <1.75kg or >1.75kg WITH asphyxia or resp. Day 2 80 mls/kg/day
distress, start with 24 hrs iv dextrose (10%) Day 3 100 mls/kg/day
 Reduce feeds by 20mls/kg/day if severe resp.
distress Day 4 120 mls/kg/day
 From Day 2 of life use 2 parts 10% dextrose to 1 part Day 5 140 mls/kg/day
HS Darrow’s (eg. 200mls 10% + 100mls HSD).
 Introduce EBM at 24 hrs unless there is asphyxia. Day 6 160 mls/kg/day
Begin with 3mls each feed if <1.5kg and 6mls each
feed if ≥ 1.5kg. Increase by the same amount every
day while reducing iv fluids to keep within the total Day 7 180 mls/kg/day
daily volume until iv fluids have stopped.

29
Nasogastric 3 hourly feed volumes for babies on full volume feeds (No RDS or asphyxia on Day 1)

g)
(k

0
1.

2.

2.

2.

2.

2.

3.

3.

3.

3.

3.

4.
t
gh

to

to

to

to

to

to
to

to

to

to

to

to
ei

9
W

1.

1.

2.

2.

2.

2.

2.

3.

3.

3.

3.

3.
Day 1 14 15 17 18 20 21 23 24 26 27 29 30
Day 2 18 20 22 24 26 28 30 32 34 36 38 40
Day 3 23 25 28 30 33 35 38 40 43 45 48 50
Day 4 27 30 33 36 39 42 45 48 51 54 57 60
Day 5 32 35 39 42 46 49 53 56 60 63 67 70
Day 6 36 40 44 48 52 56 60 64 68 72 76 80
Day 7 41 45 50 54 59 63 68 72 77 81 86 90
Intravenous fluid rates in mls / hour for sick newborns on FULL volume iv fluids.
g)
(k

.2

.4

.6

.8

.0

.2

.4

.6

.8

.0

.2

.4

.6

.8

.0
t
gh

-1

-1

-1

-1

-2

-2

-2

-2

-2

-3

-3

-3

-3

-3

-4
ei

9
W

1.

1.

1.

1.

1.

2.

2.

2.

2.

2.

3.

3.

3.

3.

3.
Day 1 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10
Day 2 4 5 5 6 7 7 8 9 9 10 11 11 12 13 13
Day 3 5 6 7 8 8 9 10 11 12 13 13 14 15 16 17
Day 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Day 5 7 8 9 11 12 13 14 15 16 18 19 20 21 22 23
Day 6 8 9 11 12 13 15 16 17 19 20 21 23 24 25 27
Day 7 9 11 12 14 15 17 18 20 21 23 24 26 27 29 30

30
 Intravenous / intramuscular antibiotics aged < 7 days Oral antibiotics aged < 7 days

Ampicillin / Gentamicin
Penicillin Ceftriaxone Metronidazole
(50,000iu/kg)
Cloxacillin (3mg/kg <2kg,
(50mg/kg) (7.5mg/kg) Ampicillin /
(50mg/kg) 5mg/kg ≥ 2kg) Amoxycillin,
Cloxacillin
iv / im iv / im iv / im iv / im iv
Weight mls susp mls susp
12 hrly 12 hrly 24 hrly 24 hrly 12 hrly
kg 125mg/5mls 125mg/5mls
1.00 50,000 50 3 50 7.5 Weight
1.25 75,000 60 4 50 10 kg 12 hrly 12 hrly
1.50 75,000 75 5 75 12.5 2.00 2 2
1.75 100,000 85 6 75 12.5 2.50 3 3
3.00 3 3
2.00 100,000 100 10 100 15
4.00 4 4
2.50 150,000 125 12.5 125 20
3.00 150,000 150 15 150 22.5
4.00 200,000 200 20 200 30

Opthalmia Neonatorum: Warning:

Swollen red eyelids with pus  Gentamicin used once daily should be
should be treated with a given im or as a slow iv bolus (push) –
single dose of: over 2-3 minutes.
 Kanamycin or  If a baby is not obviously passing urine
Spectinomycin 25mg/kg after more than 48 hours consider
(max 75mg) im, or, stopping gentamicin.
 Ceftriaxone 50mg/kg im  Chloramphenicol should not be used in
babies aged < 7 days.

31
ARI / pneumonia protocol for children aged 2 months to 4yrs.

History of cough or difficult

breathing, age > 60 days.

Cyanosis, inability to Y Very Severe Pneumonia

drink / breast feed, Oxygen,
or AVPU = ‘V, P or Chloramphenicol, OR,

Wheeze
U’, (often + other Penicillin AND Gentamicin.
respiratory signs*)

N
Y
Lower chest wall Severe Pneumonia –
Benzyl Penicillin ALONE
Wheeze

indrawing, AVPU=’A’

Age 2 – 11 months: Y Pneumonia – Amoxycillin

Respiratory rate ≥ 50, if previously had co-
Age ≥12 months: trimoxazole for this illness.
Wheeze

Respiratory rate ≥ 40 If no pre-treatment give co-

trimoxazole.
N

No pneumonia,
probable URTI.

Possible Asthma –
see separate protocol p31

* Additional signs of pneumonia / severe pneumonia: nasal flaring, grunting, indrawing,

raised RR

32
Pneumonia treatment failure definitions.
HIV infection may underlie treatment failure – testing helps the child.

See HIV page for indications for PCP treatment.

Treatment failure definition Action required

Any time.
Progression of severe pneumonia
to very severe peumonia
(development of cyanosis or
inability to drink in a child with
pneumonia without these signs on
admission)
Obvious cavitation on CXR
48 hours
Very severe pneumonia child
getting worse, re-assess
thoroughly, get chest X ray if not
already done (looking for empyema
/ effusion, cavitation etc).
Severe pneumonia without
improvement in at least one of:
 Respiratory rate,
 Severity of indrawing,
 Fever,
 Eating / drinking.
Day 5.
At least 3 of:
 Fever, temp >380C
 Respiratory rate >60 bpm
 Still cyanosed or saturation
<90% and no better than
admission
 Chest indrawing persistent
 Worsening CXR
After 1 week.
Persistent fever and respiratory
distress.
Change treatment from Penicillin
to: Chloramphenicol or continue
Penicillin and add gentamicin.
Treat with Cloxacillin and
gentamicin iv for Staph. Aureus or
Gram negative pneumonia.
Add cloxacillin iv to pen and gent.
If on chloramphenicol alone
continue for 5 days.
Suspect PCP especially if <12m,
an HIV test must be done - treat
for Pneumocystis if HIV positive
Change treatment from Penicillin to
Chloramphenicol or continue
Penicillin and add gentamicin.
a) If only on penicillin change to
Chloramphenicol, if already on
Chloramphenicol or Penicillin /
Gentamicin change to
ceftriaxone.
b) Suspect PCP, an HIV test must
be done - treat for
Pneumocystis if HIV positive.
Consider TB, perform mantoux and
check TB treatment criteria.

33
Possible asthma – admission management of the wheezy child.

Wheeze + history of cough or

difficult breathing.

Wheeze + Cyanosis, Severity = Very Severe:

inability to drink /  Oxygen
breast feed or AVPU  Nebulised salbutamol hourly until
= ‘V, P or U’. (Rarely Y improving then 4 hourly.*
severe asthma can  If 3 x 1 hourly doses given
present with a ‘silent consider adding Aminophylline.
chest’ – consider a  Antibiotics as for Very Severe
trial of treatment in a pneumonia
known asthmatic)  Start oral (prednisolone) or iv
steroids

N Severity = Severe:
 Oxygen if obvious use of other
Y accessory muscles.
Wheeze + Lower  Immediate Salbutamol by inhaler
chest wall indrawing. + spacer or nebuliser and repeat
4 hourly.
N  Antibiotics as for Severe
pneumonia
 Start oral prednisolone

Wheeze, feeding OK,

but + Severity = Mild:
Y
Age 2 – 11 months:  Oral salbutamol if recurrent
Respiratory rate ≥ 50, wheeze and age > 6 months.
Age ≥12 months:  Antibiotics as for non-severe
Respiratory rate ≥ 40 pneumonia unless clearly
asthma

* If a nebuliser is not available then 2 puffs of an inhaler into a spacer

can be repeated 5 times in 30 mins or Adrenaline 0.01ml / kg of
1:1000 (max 0.3mls) sc injection can be given. Adrenaline can be
repeated if there is no initial response – do not give more than 3 times.

34
 Emergency estimation of child’s weight from their age.

All babies and children

admitted to hospital Child looks well
should be weighed and nourished, average
the weight recorded on size for age Child looks obviously
the Child Health Card. Estimated malnourished – find
Age Weight (kg) age but step back 2
1 – 3 weeks 3.0 age /weight
categories and use
Estimate the weight from 4 - 7 weeks 4.0 the weight
the age only in 2 - 3 months 5.0 appropriate for this
emergencies or younger age-group.
exceptional 4 - 6 months 7.0
circumstances. 7 to 9 months 9.0 Eg. Child wasted and
age 10 months, use
10 to 12 months 10.0
the weight for a 4-6
1 to 2 yrs 11.0 month well nourished
As soon as possible
2 to 3 yrs 13.0 child.
check the weight and
correct it. 3 to 4 yrs 15.0
4 to 5 yrs 17.0

35